Healthcare Provider Details

I. General information

NPI: 1558899856
Provider Name (Legal Business Name): KIMBERLY MAY OVERTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16811 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-3404
US

IV. Provider business mailing address

14217 55TH AVE SE
EVERETT WA
98208-9354
US

V. Phone/Fax

Practice location:
  • Phone: 360-735-8100
  • Fax: 360-253-1781
Mailing address:
  • Phone: 360-353-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61098207
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: